Local anesthetics contraindications

Yohimbine (104), also from the bark of C.johimbe K Schum. and from the roots of R. serpentina (1. ) Benth. has a folk history (unsubstantiated) of use as an aphrodisiac. Its use has been confirmed experimentally as a local anesthetic, with occasional employment for rehef ia angiaa pectoris and arteriosclerosis, but is frequently contraindicated by its undesired renal effects. Yohimbine and some of its derivatives have been reported as hahuciaogenic (70). In addition, its pattern of pharmacological activities ia a variety of animal models is so broad that its general use is avoided. All ten carbon atoms of secologanin (102) as well as the entire skeleton of tryptamine (98, R = H) are clearly seen as iatact portions of this alkaloid. 

Because of its anticholinergic properties, disopyramide should not be used in patients with glaucoma. Urinary retention and benign prostatic hypertrophy are also relative contraindications to disopyramide therapy. Patients with myasthenia gravis may have a myasthenic crisis after disopyramide administration as a result of the drug s local anesthetic action at the neuromuscular junction. The elderly patient may exhibit increased sensitivity to the anticholinergic actions of disopyramide. 

Contraindications include hypersensitivity to local anesthetics of the amide type (a very rare occurrence), severe hepatic dysfunction, a history of grand mal seizures due to lidocaine, and age 70 or older. Lidocaine is contraindicated in the presence of second- or third-degree heart block, since it may increase the degree of block and can abolish the idioventricular pacemaker responsible for maintaining the cardiac rhythm. 

B. Anticholinergic agents, such as procainamide and disopyramide, are relatively contraindicated in patients with glaucoma. Procainamide is hypotensive rather than hypertensive. The local anesthetic activity of procainamide would have no adverse interaction with the diabetes mellitus. 

Contraindications Hypersensitivity to benzocaine or ester-type local anesthetics, perforated tympanic membrane or ear discharge (otic preparations)... 

Contraindications History of hypersensitivity to beta-lactams (imipenem and cilas-tin, meropenem), hypersensitivity to amide-type local anesthetics (IM)... 

Contraindications IM Severe shockor heart block, hypersensitivity to local anesthetics of the amide type. 

Contraindications Adams-Stokes syndrome, hypersensitivity to amide-type local anesthetics, septicemia (spinal anesthesia), supraventricular arrhythmias, Wolff-Par-kinson-White syndrome... 

Contraindications Hypersensitivityto ester local anesthetics, sulfites, PABA, patients on anticoagulant therapy, and in patients with coagulopathy, infection, thrombocytopenia, Should not be given via intra-arterial, intrathecal, or intravenous routes. 

Contraindications Hypersensitivitytocarbonicanhydraseinhibitors, local anesthetics, salicylates, sulfonamides, sulfonylureas, sunscreens containing PABA, or thiazide or loop diuretics intestinal or urinary tract obstruction porphyria severe hepatic or renal dysfunction... 

Contraindications Hypersensitivity to esther local anesthetics, sulfites, PABA, infection or inflammation at the injection site, bacteremia, platelet abnormalities, thrombocytopenia, increased bleeding time, uncontrolled coagulopathy, anticoagulant therapy, sulfonamide therapy. 

Contraindications Hypersensitivity to local anesthetics, second- or third-degree AV block... 

Contraindications Hypersensitivity to benzocaine or similar local anesthetics... 

Generally, local anesthetics can be used with little risk of significant adverse local or systemic effects. The following specific contraindications should help to ensure the safe and effective ocular use of these anesthetics. 

The use of benzyl alcohol as a local anesthetic was previously discussed. It is also used as a preservative in parenteral dosage forms. However, there is some evidence that benzyl alcohol is neurotoxic and its use is contraindicated in the United Kingdom in children under 3 years of age. ° ... 

Hypersensitivity to amide-type local anesthetics, Adams-Stoke syndrome, supraventricular arrhythmias, Wolf-Parkinson-White syndrome. Spinal anesthesia contraindicated in septicemia. Caution Dosage should be reduced for elderly, debilitated, acutely ill safety in children has not been established. Severe renal/hepatic disease, hypovolemia, CHF, shock, heart block, marked hypoxia, severe respiratory depression, bradycardia, incomplete heart block. Anesthetic solutions containing epinephrine should be used with caution in peripheral or hypertensive vascular disease and during or following potent general anesthesia. Sulfite sensitivity or asthma for some local and topical anesthetic preparations. Tartrazine or aspirin sensitivity with some topical preparations. Anxiety, insomnia, apprehension, blurred vision, loss of hearing acuity, and nausea CNS depression, convulsion and respiratory depression... 

Trimethobenzamide is contraindicated in patients with hypersensitivity to benzocaine, or other local anesthetics. The injectable form is contraindicated in neonates and premature infants. 

Some of the vasoconstrictor may be absorbed systemically, occasionally to an extent sufficient to cause untoward reactions (see below). There also may be delayed wound healing, tissue edema, or necrosis after local anesthesia. These effects seem to occur partly because sympathomimetic amines can cause hypoxia and local tissue damage. The use of vasoconstrictors in local-anesthetic preparations for anatomical regions with Umited collateral circulation could produce irreversible hypoxic damage, tissue necrosis, and gangrene, and therefore is contraindicated. 

See local anesthetics listing provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more available on the book s Web site (see URL in Appendix). 

For routine post-operative analgesia, we rely on acetaminophen, local anesthetics, NSAIDS if not contraindicated, and, finally, opiates. Even if pain control is adequate without opiates, small doses of fentanyl may be used at the time of emergence to ease a patient through emergence delirium and the first moments in PACU when even parental presence is not a comfort... 

An allergic reaction to specific agents is an obvious contraindication. Allergy to para-aminobenzoic acid (PABA) is a contraindication to use of ester local anesthetics due to the fact that PABA is a metabolic product of ester metabolism. Methylparaben is a common preservative chemically similar to PABA and likewise can cause an allergic reaction. Metabisulfite is a commonly used preservative that may also cause allergic reactions but more notably is neurotoxic when used intrathecally. Local anesthetics containing any preservative should not be used intrathecally. Ester local... 

Synera is contraindicated in patients with a known history of sensitivity to lidocaine, tetracaine, or local anesthetics of the amide or ester type. Synera is also contraindicated in patients with para-aminobenzoic acid (PABA) hypersensitivity. 

Local anesthetics, such as lidocaine, are metabolized in the liver and excreted by the kidneys. Acute or chronic deterioration of renal function can lead to their inadequate clearance. Use of local anesthetics is not contraindicated in CKD patients with eGFR <50 ml/min, but dosages should be kept to a minimum and the interval between injections adequately extended. 

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